Christian was rescued from a chemical abortion in 2016.
A woman who would like to learn more about reversing the effects of chemical abortion and possibly continuing her pregnancy should call the Abortion Pill Reversal (APR) hotline at 877-558-0333 or go to the APR website to begin a live chat. The Abortion Pill Rescue Network™ (APRN) has nurses waiting to answer questions, explain reversal, and connect her with an APR provider in her area.
Healthcare professionals with prescribing privileges can go to our provider website, click Join Our Medical Network, and specify that you would like to "provide progesterone treatment.” After receiving the information, we will confirm eligibility and add the medical provider and/or clinic to the APR Provider list. This list is used by our nurses when a client in your area requests a reversal.
We will also send you the APR Kit, which includes a program description, protocol, and documents used throughout the reversal process as well as several research articles.
A Pregnancy Help Medical Clinic (PHMC) offering APR services provides progesterone by dispensing onsite or through a prescription, confirming the viability and dating of the pregnancy with ultrasound, and the prescribing physician sees the patient (either at the center or in his/her office), ideally within 72 hours.
The other option for centers is to become a "consulting" center. These centers educate and refer for APR and offer free ultrasounds. They seek funding for clients in their community who cannot pay for the progesterone prescription or appointment. And they offer pregnancy and community support for women who have attempted reversal. This is the link to enroll as an APR provider or consulting center.
APRN Medical Director, Dr. Brent Boles, and APRN Advisory Team: Dr. Matt Harrison, Dr. George Delgado, Dr. William Lile, Dr. Julie McDonald, Dr. Karen Poehailos and Dr. Catherine Stark.
by Bryan Williams, MHA, RT(R), RDMS, RVT, RDCS, LAS, Ultrasound Specialist, Tammy Stearns, MS, RDMS, RVT, RT(R), FSDMS, FAIUM, LAS, Ultrasound Specialist, and Christa Brown BSN, RN, LAS, Senior Director of Medical Impact
Even after your primary training is complete and the initial ultrasound skills are mastered, there remains the question of how to retain competency. To best help the women and families we serve, our skills must remain up-to-date to provide relevant information, clear images, and accurate reports. This leads to several areas of discussion regarding the specific requirements needed to maintain competency. Given that each imager is different, each pregnancy help medical clinic (PHMC) has its own number of scans per day and that leads each of them to have their own guidelines for what is necessary to remain competent. It is no surprise that there are varying opinions on what should be required to maintain competency.
We live in a world where medical professionals are constantly running up against new “rules” and recommendations. Different organizations working to improve quality often set arbitrary rules on how to retain skills and remain competent in the field. This is likely done with good intentions and oftentimes leads to a variation of many different ideas and suggestions dependent on the focus of that specific organization.
Training and teaching people is one of the most dynamic activities that occurs in this world. As with any user-dependent learned skill, ultrasound requires continual practice and education throughout an imagers career. These vary greatly dependent on the natural ability of the imager and the foundational level of education specific to ultrasound, making it difficult to set a required number. Heartbeat International recommends the policies set by the Medical Director of that specific PHMC regarding the requirements to maintain competency in conjunction with any federal or state licensure or legal requirements.
Heartbeat International recommends quarterly or bi-annual peer reviews. In a peer review, all staff performing ultrasounds have a quarterly peer review which assesses the quality of an exam provided by experienced nurses and sonographers. The cases are chosen randomly and are reviewed blindly. A peer review includes an assessment ensuring that all required forms are being completed thoroughly and properly and all protocols of imaging and measurements are being followed. Any issues revealed in a peer review are corrected with feedback, goals set, and continued education.
The minimum requirement for continued education differs dependent on several factors. Registered Nurses are governed by their licensing board which is dependent on the state in which the board oversees. Registered Diagnostic Medical Sonographers' requirements are dependent on the requirements of the organization that has awarded their credentials, along with state licensure laws dependent on their state.
However, these are specific to the credentials of the professional, not necessarily specific to imaging limited obstetrical ultrasounds. Because each medical professional has a different skill set and frequency of scans in their clinic, some may be experiencing very few scans. Because of this, less pathology is being seen and less diversity of images and gestational ages. This makes it challenging to maintain proficiency. Policies need to be set within each PHMC to ensure that competency within the level of imaging being seen is maintained.
Heartbeat International recommends that only licensed or credentialed medical personnel trained in limited obstetrical ultrasounds (nurses, registered diagnostic medical sonographers, nurse practitioners, midwives, physicians, and physician assistants) perform scans within PHMCs.
Just as when you started your training, continued education should be a combination of didactic and clinical learning. Maintaining skills ensures you remain competent and confident in your ultrasound skill to image life most effectively.
If your PHMC has a team of medical professionals who have experience in ultrasound scanning, periodic group training may be helpful. This could be a time to review didactic material, share difficult cases, and perhaps perform a few practice scans. Consider scheduling a time for group training, overseen by experienced nurses and sonographers within your PHMC or even with a few clinics combined, who can provide feedback, support, and insight. Personal and dependent growth continues far beyond the initial training period.
For those that have a smaller or newly developed medical department, Heartbeat International offers a didactic ultrasound refresher course that allows continued education online. The course is reissued every two years to allow for a continual source of learning for the more experienced imagers. In addition to the didactic components, there is a clinical component that requires ten exams to be completed along with an assessment completed by an experienced observer. For those without an experienced observer, personal arrangements may be made.
Another more in-depth option would be to attend the clinical training, L.O.V.E. Approach Ultrasound Clinical, which is available to all levels of ultrasound proficiency. These events are also great for those who have been scanning for many years and have proven to be a time of encouragement while fine-tuning existing skills.
At times, it can be difficult to navigate all the legal requirements for the services PHMCs offer. However, it may be more difficult to navigate the areas that are not legally governed. These gray areas are often met with suggestions from organizations that do not govern ultrasound or medical services but rather have an opinion on what is best for all. That can add to the confusion of what is actually a requirement and what is a guideline or recommendation. As you discern what is best for your PHMC and the community you serve, it can be helpful to consider a few things:
Together, these things can guide policy for your PHMC in light of the purpose of the scan…to image life.
Thank you for all you do for your communities. You put your heart into your work and want the very best for the women, babies, and families you serve. You are making a difference.
by Christa Brown, Senior Director, Medical Impact, Heartbeat International
As the U.S. Food and Drug Administration (FDA) continues to relax safety measures for mifepristone/misoprostol abortion, the abortion industry shrugs off any responsibility for their part in creating significant hazards to women's health. Despite significant evidence of risk, the FDA continues to modify the Risk Evaluation and Mitigation Strategy (REMS) safety net for mifepristone. Currently, chemical abortion may be administered without a physical exam or ultrasound to confirm the location and age of the pregnancy, Rhesus antigen (Rh) status testing, or any interaction with a medical professional. The American Association of Prolife Obstetricians and Gynecologists (AAPLOG) cautions that “removing all testing recommendations (previously considered standard of care) is such a new approach that studies do not exist to demonstrate the full range of adverse events” that will soon present themselves and that “…complications will undoubtedly be higher.” Big Abortion continues to demonstrate that abortion at all costs, as well as higher profit margins, are the priority as they further distance themselves from real healthcare.
The abortion pill may be dispensed at a clinic or through a telehealth visit, which is completed by phone or video chat. Chemical abortion is also available on more than 70 websites and several funnel abortion services to areas they deem are underserved—delivering directly to the woman’s doorstep. According to the Abortion Pill Rescue® Network, the number of women obtaining the abortion pill online or from a friend has increased tenfold in the last three years.
At the Abortion Pill Rescue Network (APRN), we've sadly seen a reduction in pre-abortion exams or ultrasounds before the start of their abortions. These are the percentages of women who called the APR Hotline who received an ultrasound before starting an abortion from 2017-2022:
Even when an ultrasound is performed, many women share with APRN nurses that they were not provided the vital information from the scan and do not know if their babies had a heartbeat, the dating of the pregnancy, or if the pregnancy was confirmed to be intrauterine. Because of the failure of the FDA to protect women, there is a gap in information, care, and resources for those considering all options in pregnancy.
Typically, these appointments are helpful for those who are:
Pregnancy help medical clinics (PHMCs) are in a unique position to offer no-cost medical assessments, safety plans and personal support. Offering a pre-abortion screening is one way to empower women with information about the details of their pregnancies and the choices available to them.
Each center serves its unique community and tailors their services to the needs of the families they serve. Many centers are already offering pre-abortion screenings and have shared that this service is nothing new–just a combination of what they have been doing all along. These clinics offer more choices than abortion facilities and provide concrete solutions to help families overcome barriers to healthy pregnancies.
PHMCs want families to focus on their own needs, not on how they will pay for care or support. Unlike abortion facilities, PHMCs offer all services without cost to the client. The pre-abortion assessment is an opportunity for a woman considering choices to obtain a free consultation with a licensed healthcare professional who will provide evidence-based information about all her options. Since many women are prescribed the abortion pill with little or no interaction with a healthcare professional, there is immense value in this visit. The PHMC healthcare professional will take the time to answer all the patient’s questions and ensure she makes an informed choice; patients are not pressed to decide for the sake of quick profit.
Pregnancy testing is performed by medical professionals, and the results are provided to the patient during the appointment. There are two types of pregnancy tests: a urine sample, and a blood sample. Both pregnancy test types detect the presence of a hormone called human chorionic gonadotropin (hCG). When an egg is implanted in a woman’s uterine lining, hCG hormones begin to develop and multiply. This is a presumptive sign of pregnancy and the PHMC can confirm the patient’s home test results.
AAPLOG recommends an “ultrasound and exam before medication abortion to confirm gestational age” and that “[to] evaluate for ectopic pregnancy [is] important to maternal safety.” They also confirm that informed consent is a professional obligation, and it would be impossible to tailor counseling about chemical abortion to each patient if an ultrasound were not performed.
Some states require women to have an ultrasound exam before an abortion, but these are becoming fewer and fewer. The frequency of ultrasound by abortion providers decreased during the pandemic when “no touch abortions” were advertised. Now those who sell abortion through telehealth or websites have profited from this omission. However, ultrasound is a common service of PHMCs.
The need for an ultrasound before an abortion is threefold:
The ACOG recommends that “Rh D immune globulin be given to Rh-negative women having any type of abortion.” Yet one-third of Americans do not know their blood type so it would be challenging to do this without testing. The AAPLOG recommends that “all pregnant women undergoing medication abortion or otherwise should be evaluated for Rh status.” PHMCs can offer this simple testing to protect women and future pregnancies from complications.
Mayo Clinic explains that risk occurs when even a small amount of the baby's blood could come in contact with the mother’s blood. This can happen if there is bleeding during pregnancy, such as during a chemical abortion, but can be prevented by Rh testing early in pregnancy.
Health problems usually do not occur during a Rh-negative woman’s first pregnancy with a Rh-positive baby. This is because her body does not have a chance to develop a lot of antibodies. The AAPLOG warns that ignoring these recommendations to test pregnant women before abortion may have significant consequences for future pregnancies.
Rh factor is typically determined with a complete panel during an early prenatal visit but can be performed with a fingerstick using a blood-typing kit in a PHMC.
Chemical abortion can cause a significant amount of bleeding and sometimes even hemorrhaging. This extra blood loss increases the risk of blood transfusion for those who are anemic. The Cleveland Clinic explains that iron deficiency is common in pregnancy. The chances of needing a blood transfusion after an abortion are increased if the patient is already anemic.
Anemia during pregnancy, defined as hemoglobin (Hb) < 10.5–11 g/dL, is experienced by as many as 40% of women. Anemia following pregnancy is associated with an increased risk for blood transfusion, postpartum depression, and increased mortality.
The World Health Organization estimates that approximately 27% of maternal deaths are due to obstetric hemorrhages. Typically a simple fingertip prick can determine iron levels which can be performed in a PHMC setting.
The Centers for Disease Control estimates that one in five people (more than 26 million) in the United States have a sexually transmitted disease. According to the National Library of Medicine, pelvic infection is the most common complication of abortion, and the presence of an existing lower genital tract infection increases the risk of complications. According to this study, women seeking abortion “are at significant risk of harboring sexually transmitted diseases (STDs)” and, when combined with an abortion, can lead to long-term pelvic pain and fertility issues. Since STDs can be asymptomatic, women can reduce their risk of complications after an abortion by testing and obtaining treatment before starting an abortion.
Many centers already offer this service and can include this as part of their pre-abortion screening.
All women considering abortion should know that their options do not end when they consume the first chemical in an abortion. The possibility exists that she can continue her pregnancy if she has regret after taking mifepristone and help is available 24 hours a day to do so. Abortion pill reversal has a nearly 70% success rate and APRN data shows that more than 4,500 lives have been saved through the APRN. No woman should be forced to complete an abortion she no longer desires, and she must be aware of this possibility before the start of the abortion so she can seek reversal treatment as soon as possible.
Chemical abortion is always self-managed, typically in the home of the patient. Yet abortion with mifepristone and misoprostol has four times the complications of surgical abortion. Patients must determine when bleeding or pain requires urgent medical attention, and oftentimes women are alone in the process. While privacy and the comfort of home might sound appealing as she makes an abortion choice, it can be alarming when emergency care is needed. Before consuming the abortion pill, patients need to consider:
The patient and support person should have a plan for when to obtain urgent care in the days after the abortion. She should seek medical attention right away if she has:
Having a plan in place before consuming abortion drugs is essential to ensure safety. The AAPOG states that “chemical abortion is contraindicated if there is no access to medical facilities for emergency services” under the black box warning assigned.
At the emergency department, the patient must explain what medications she has consumed and her precise symptoms. If available, the FDA advises the patient to take the Medication Guide for Mifeprex when seeking medical care so that it can be readily understood that she is undergoing a chemical abortion.
A follow-up plan should be made with a trusted healthcare provider about 7 to 14 days after taking the abortion pills to be sure that the abortion is complete and there are no complications that could lead to infection and hemorrhage. PHMCs have referrals for trusted obstetricians in their communities that can ensure the well-being of these patients following an abortion.
In every pregnancy, there are two patients: two lives, two heartbeats, and two sets of DNAs. Pre-abortion screening enables PHMCs to care for and protect both patients.
PHMCs advocate for women, not just before the choice is made but afterward, too. Sometimes the answers are not a “quick fix,” and the road to a pregnancy decision may require time and tangible assistance. PHMCs ensure the long-term well-being of their patients and their children and understand that the answer to an unexpected pregnancy is not a “quick fix” that the abortion industry promotes.
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